The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic.

UK National Institute for Health Research Health Technology Assessment Programme.

A single instillation of chemotherapy immediately after resection reduces the risk of recurrence in non-muscle-invasive bladder cancer; however, it should not be given to patients at high risk of recurrence due to its lack of efficacy in this subgroup.

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ObjectivesThe aim of this study was to assess the test performance and clinical effectiveness of photodynamic diagnosis (PDD) compared with white light cystoscopy (WLC) in people suspected of new or recurrent bladder cancer. MethodsA systematic review of randomised controlled trials (RCTs), non-randomised comparative studies or diagnostic cross-sectional studies comparing PDD with WLC. Fifteen electronic databases and websites were searched (last searches April 2008).For clinical effectiveness only RCTs were considered. ResultsTwenty-seven studies (2949 participants) assessed test performance. PDD had higher sensitivity than WLC (92%, 95% CI 80 to 100% versus 71%, 95% CI 49 to 93%) but lower specificity (57%, 95% CI 36 to 79% versus 72%, 95% CI 47 to 96%). For detecting higher risk tumours, median sensitivity of PDD (89% (6 to 100%)) was higher than WLC (56% (0 to 100%)) whereas for lower risk tumours it was broadly similar (92% (20 to 95%) versus 95% (8 to 100%)). Four RCTs (709 participants) using 5-aminolaevulinic acid (5-ALA) as the photosensitising agent reported clinical effectiveness. Using PDD at transurethral resection of bladder tumour (TURBT) resulted in fewer residual tumours at check cystoscopy (relative risk (RR) 0.37, 95% CI 0.20 to 0.69) and longer recurrence-free survival (RR 1.37, 95% CI 1.18 to 1.59), compared with WLC. 4 ConclusionsPDD detects more bladder tumours than WLC, including more high risk tumours.Based on four RCTs reporting clinical effectiveness, 5-ALA mediated PDD at TURBT facilitates a more complete resection and prolongs recurrence-free survival.